AAFP News Now: AFP Edition

Policy and Health Issues in the News

Congress passed legislation to reverse the 10.6 percent cut in Medicare payment rates that was scheduled for July 1, 2008. After the July 4 holiday recess, the Senate voted in favor of H.R. 6331, which maintains physician payment levels for the remainder of 2008 and provides a 1.1 percent payment increase in 2009. A 10.1 percent reduction in payment rates had been scheduled for January 2008; however, Congress voted to postpone that cut until July 1, 2008. President Bush has threatened to veto H.R. 6331, although both the House and Senate approved the bill by wide enough margins to override a veto if necessary. American Academy of Family Physicians (AAFP) President Jim King, MD, Selmer, Tenn., hopes that Congress will use the next 18 months to develop an alternative to the sustainable growth rate, the formula currently used to calculate Medicare payment rates. For more information, visit https://www.aafp.org/news-now/government-medicine/20080709medicare-bill-passes.html.

Americans are forgoing or delaying medical care at a growing rate, according to a report from the Center for Studying Health System Change. The report found that cost and access are the most common obstacles to medical care. In 2007, about 59 million people indicated that they had forgone or delayed care, compared with 39 million people in 2003. The report found that between 2003 and 2007, the number of Americans who had an unattended medical need increased by 9.5 million and the number of Americans reporting delayed care increased by 13.5 million. Without a plan to contain costs, the report estimates that the government will need to help insurance companies keep costs down for families and individuals, which is not thought to be a sustainable solution. Although the report shows that uninsured patients continue to struggle with health care access more than insured patients, those with insurance have a higher percentage of unmet medical needs because of the rising costs of deductibles, coinsurance, and copayments. The shortage of primary care physicians is one significant cause of the health care access problems. AAFP Board Chair Rick Kellerman, MD, Wichita, Kan., expects the problems to get worse, with the number of retiring family physicians exceeding the number of medical students entering family medicine each year. For more information, visit https://www.aafp.org/news-now/professional-issues/20080708kellerman-hsc.html or http://hschange.org/CONTENT/993/.

The number of U.S. physicians using electronic health records (EHRs) may be lower than previously estimated. A report published in the July 3, 2008, issue of the New England Journal of Medicine, “Electronic Health Records in Ambulatory Care—A National Survey of Physicians,” reveals that only 4 percent of physicians have implemented a fully functional EHR system in their practice, and only 13 percent have a basic EHR system. Researchers believe that previous estimates of EHR adoption rates were higher (between 9 and 29 percent) because earlier studies had a small number of respondents or an incomplete definition of an EHR. The survey also sought physician satisfaction levels with their EHR systems and what effect, if any, it had on the quality of care they were able to provide patients. Respondents with fully functional and basic EHRs were generally satisfied with their systems and thought they improved quality of care. The report found that the largest barrier to EHR adoption was cost, followed by an inability to find a system to match the physician's needs and concern about return on investment. For more information, visit https://www.aafp.org/news-now/practice-management/20080626ehr-survey.html or the New England Journal of Medicine Web site at http://content.nejm.org/cgi/content/full/359/1/50.

Aligning Forces for Quality Program Aims to Create National Model for Health Care

The Aligning Forces for Quality program will begin phase two of an initiative designed to improve health care across the country. The program, which is funded by the Robert Wood Johnson Foundation, was designed to improve health care in 14 communities across the United States. The program's first phase, launched in 2006, focused on improving care for chronic illness in the outpatient setting. The second phase will focus on four objectives, including helping physicians improve quality of care, providing patients with better information to make choices about their care, improving hospital care, and reducing health care inequities among different races. According to program director Bruce Siegel, the goal of the initiative is to create a health care model that can be reproduced in other areas nationwide. The Robert Wood Johnson Foundation is investing $300 million for the program's second phase, which will be used to provide resources to patients and physicians. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20080625rwjcareplan.html or the Aligning Forces for Quality Web site at http://rwjf.org/qualityequality/af4q/index.jsp.

Congress Blocks Reduction in Medicaid Matching Funds for GME Programs

Congress recently passed a $161.8 billion supplemental spending bill that postpones reductions in Medicaid matching funds. President Bush is expected to sign H.R. 2642, which would save graduate medical education (GME) programs more than $1 billion during the next five years. The bill blocks the implementation of six Medicaid rules that were issued by the U.S. Department of Health and Human Services, which are scheduled to take effect on April 1, 2009. Two of the rules would prevent states from using federal matching funds for GME and from obtaining Medicaid matching funds for money spent by public hospitals. The matching funds assist medical schools and teaching hospitals with covering the costs of educating and training physicians. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20080702gme-funds.html.

NIH Trial Results Unable to Explain Number of Deaths in Intensive Treatment Group

The National Institute of Health's (NIH's) National Heart, Lung, and Blood Institute halted one arm of its ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial earlier this year after a high number of deaths. Results from the intensive glucose-lowering arm of the study appear in the June 12 issue of the New England Journal of Medicine. This arm of the trial aimed to reduce blood glucose to near normal levels in adults with type 2 diabetes at high risk of heart attack and stroke. These patients had a 22 percent higher risk of death compared with those who participated in the less intensive arm of the study, which focused on lowering blood glucose to standard treatment levels. Although researchers could not identify the exact cause of the increased risk of death, possibilities include the higher number of medications, combinations of medications, and changed medications and doses used in the intensive arm. For more information, visit https://www.aafp.org/news-now/clinical-care-research/20080702accord-results.html or the New England Journal of Medicine Web site at http://content.nejm.org/cgi/content/full/358/24/2545.

The Pharmaceutical Research and Manufacturers of America (PhRMA) has updated its marketing code to improve interactions between pharmaceutical company representatives and health care professionals. The code aligns with the ongoing movement to ensure that relationships between representatives and physicians do not compromise patient care. Changes to the code include restrictions on providing physicians with noneducational gifts, restaurant meals, and company-sponsored meals at continuing medical education events. The code also outlines provisions for health care professionals who serve on companies' speakers bureaus, as well as guidelines for creating accurate and balanced promotional materials. For more information, visit https://www.aafp.org/news-now/professional-issues/20080710phrma-code.html or PhRMA's Web site at http://www.phrma.org/files/PhRMA%20Code.pdf.

Medical schools can do more to provide students with help in managing their debt, according to the American Medical Association (AMA) House of Delegates. Members who testified at the AMA Reference Committee on Medical Education emphasized the role student debt plays in choice of specialty and practice location, sometimes deterring students from careers in primary care. Delegates passed resolutions encouraging the AMA to support several measures aimed at medical schools, including requiring them to provide information about government and private loans and to disclose the use of all tuition and fee increases. Resolutions also called for the consideration of a shorter medical school curriculum, identification of work-study options, and development of paid rotating internships for fourth-year students. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20080627ama-med-debt.html.

The U.S. Drug Enforcement Administration (DEA) has proposed new regulations to allow electronic prescribing (e-prescribing) of controlled substances. If approved, physicians could add Schedule II drugs to the list of medications they e-prescribe. The proposal would help reduce errors from poor handwriting and misunderstood verbal prescriptions, as well as improve office efficiency with a consistent process for all medications. For more information, visit https://www.aafp.org/news-now/practice-management/20080709-dea-e-prescribe.html.